Provider Demographics
NPI:1255336681
Name:WENDLING, GLENDA KAY (FNP)
Entity type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:KAY
Last Name:WENDLING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N MILFORD DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-7308
Mailing Address - Country:US
Mailing Address - Phone:317-739-4848
Mailing Address - Fax:317-346-4062
Practice Address - Street 1:55 N MILFORD DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-7308
Practice Address - Country:US
Practice Address - Phone:317-739-4848
Practice Address - Fax:317-346-4062
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000057A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200310920Medicaid
IN143760EMedicare ID - Type Unspecified
IN200310920Medicaid